The present invention relates to electronic medical record (EMR) systems and in particular to an EMR system allowing access to and entry of data by a patient to request and schedule appointments and medical resources for the patient.
Scheduling of medical providers, equipment, laboratory services, and other resources for patient appointments is a significant challenge in efficiently controlling medical resources and costs. Typically, scheduling is controlled by employees in a clinic or other medical facility, who communicate with the patients by phone and arrange the schedules manually. While, in some cases, these employees can arrange all of the resources required for a visit, frequently patients are required to schedule multiple procedures in a series of tests through a series of phone calls to different employees handing scheduling for related, but separate, facilities. Such arrangements can be time consuming and inefficient, both for the patients and the medical facilities.
Enlisting patients as active participants in their own healthcare can increase patient satisfaction and the quality of the healthcare experience while decreasing the cost of providing that care. One area in which patient satisfaction can be dramatically improved, therefore, is in providing greater control and easier access for the patient to request and schedule appointments for medical care. Providing such control to the patient also affords benefits to the medical facilities, as when scheduling is done by the patient, there is a reduced need for scheduling personnel.
As it is desirable to allow patients access to scheduling of their procedures in order to improve efficiency, a number of medical communities have used the Internet to allow patients to request, or in limited cases directly schedule appointments. These systems, however, have not proved to be particularly efficient for a number of reasons. First, known scheduling systems typically provide scheduling capabilities only in predetermined increments of time. These systems, therefore, cannot tailor the amount of time necessary for an appointment to the reason for the appointment, and therefore are not efficient in scheduling the time of medical personnel and resources.
Second, when patients schedule their own appointments, it is difficult for medical personnel to obtain necessary information from and provide necessary information to the patients prior to the visit. Therefore, for example, patients can arrive for appointments, and spend up to an hour filling out forms prior to meeting with a doctor. Additionally, as the medical practitioner does not know the reason for the visit prior to the arrival of the patient, the medical practitioner cannot prepare for the visit by providing instructions to the patient prior to the visit. This problem is particularly acute when evaluation of a medical problem requires multiple steps, such as, for example, laboratory work prior to meeting with a medical practitioner. Inadequate information, therefore, often result in return visits, which could have been easily avoided had sufficient information been available to both the patient and the physician.
After appointments are scheduled and a short time before the time slot reserved for an appointment, a patient travels to the facility at which the appointment is scheduled to take place, checks in for the appointment with a receptionist, completes necessary forms, typically waits in a waiting room to be called for the appointment, is moved into a room to participate in the appointment and, after the appointment is completed, checks out with a receptionist and leaves the facility at which the appointment occurred. Here, to expedite the check-in process, patient check-in kiosks are known that receive unique patient identifying information from a patient during a check in process and, when the identifying information is recognized by the kiosk, the kiosk allows the patient to check in for appointments. An exemplary check in kiosk is the MEDIKIOSK™ that by Galvanon.
In many cases it is optimal for a patient that is to participate in several different activities (e.g., tests, examinations, procedures, etc.) at a facility to schedule appointments substantially consecutively (i.e., cluster appointments) so that the patient can attend several appointments during a single visit to the facility instead of requiring multiple facility visits to complete the appointments. Thus, where a patient has to participate in first through fourth different activities at a facility, it may be desirable to schedule the first, second, third and fourth activities for consecutive time slots at 8:00 a.m., 8:30 a.m., 9:00 a.m. and 9:30 a.m., respectively. Scheduling software is known that allows patients or a facility scheduling employee to view existing appointments and to select open time slots for additional appointments that need to be scheduled for the patient where the selected time slots are temporally proximate currently scheduled appointments.
While appointment clustering is often optimal, sometimes appointments cannot be clustered because, when the appointments are scheduled, either (1) consecutive open time slots for resources required to complete activities are not available, (2) the patient associated with the appointments has previous time commitments that will not allow clustering or (3) one of the tests is dependent on the results of an earlier test. Thus, in many cases, despite efforts to cluster, consecutive appointments may be spaced apart by intermediate periods of an hour or more or appointments may have to be made on separate days despite the fact that the appointments will take place at the same facility.
One other scheduling issue that impedes optimal appointment clustering is that resource availability, patient schedules and unfulfilled orders often change in a fluid fashion so that the constraints on clustering a specific subset of appointments change over time. Thus, what a patient may think today is optimal appointment scheduling for a subset of appointments to take place two week from now may be far less than optimal next week or on the day that the appointments are to occur. For instance, when a first patient uses a kiosk to schedule first through third appointments two weeks prior to the day on which the appointments are to occur, schedules of resources required to complete the first through third appointment activities may be such that a first one hour intermediate period is required between the first and second appointments and a second one hour intermediate period is required between the second and third appointments. Nevertheless, on the day that the first through third appointments are to take place, it may be that a second patient cancels her appointment that was to occur during the first one hour intermediate period so that, optimally, the first patient's third appointment could be moved to the first one hour intermediate period.
As another instance, when a first patient uses an online kiosk to schedule first through third appointments approximately two weeks prior to the time when the patient would like the appointments to occur, the patient's own time commitments may not allow the patient to schedule the three appointments on the same day. Here assume that the patient's own time commitments require that the patient schedule the first through third appointments on first, second and third different days. In this example, it may be that the patient's time commitments change two days prior to the first appointment so that the patient could complete all of the first through third appointments on the first day and thereby avoid trips to the facility on the following two consecutive days.
As still one other instance, in many cases patient's are unaware of or have forgotten activities in addition to activities for which appointments have already been scheduled, that should be, could be, must be, or have been ordered to be performed at a facility prior to attending an appointment at the facility. Exemplary activities that a patient may be unaware of or may have forgotten include existing or standing physician orders for tests, procedures, examinations, consultations, etc., routine best practices procedures (e.g., a yearly physical for anyone over 50 years old, a yearly colonoscopy for men over 50 years old, etc.), prerequisite activities required before specific types of appointments, etc.
One solution to the problems associated with fluid patient and resource schedules and changing activities associated with patients has been to provide receptionists with access to scheduling software to allow receptionists to optimize scheduling whenever patient's check in for appointments. Here, known receptionist check in software provides notices to receptionists when a patient that is checking in has unfulfilled orders (i.e., physician orders for patients that have been requested but have not been scheduled). When the receptionist recognizes that a patient has unfulfilled orders, the receptionist has the ability to access separate standard appointment scheduling software and search for time slots to add appointments for the patient's unfulfilled orders. When one or more time slots for one or more unfulfilled orders is identified, if the patient agrees, the receptionist can add the appointment to the patient's schedule.
While providing scheduling software to receptionists works well in theory, in practice, this solution has not proven very successful for several reasons. First, at many times medical facility receptionists are inundated with patients checking in for appointments and simply cannot take additional time with each patient during check in to attempt to optimize patient appointment clustering. This is particularly true in cases where receptionists are required to use standard scheduling software to schedule new appointments as standard scheduling software tends to be rather complex and requires several steps and associated time to identify and select possible time slots for activities.
Second, many receptionists are not well trained in how to use scheduling software and therefore are uncomfortable tinkering with currently scheduled appointments. This is particularly true in cases where appropriateness of a time slot for an appointment may hinge on many factors in addition to whether or not the time slot is open for a required resource (e.g., rules governing which procedures can follow other procedures, required pre-appointment patient preparation, etc.).
Third, even when a receptionist is trained in using scheduling software and there is no backlog of patients checking in for appointments, in many cases the receptionist opts not to attempt to optimize patient schedules because there is no direct benefit to the receptionist by performing the additional activities (i.e., the benefit of an altered appointment is directly to the patient and the facility that increases utilization rates of resources, not the receptionist).